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Iteration of the Human Atrioventricular (AV) Nodal Recovery Curve Predicts Many Rhythms of AV Block

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Theory of Heart

Part of the book series: Institute for Nonlinear Science ((INLS))

Abstract

The atrioventricular nodal recovery curve provides a quantitative description of how the conduction time through the atrioventricular node of a prematurely elicited atrial beat increases as the recovery time since the immediately preceding activation of the bundle of His decreases. This curve can be well approximated in human beings with normal atrioventricular nodal function by a single exponential function (the “standard” curve). Assuming that the response of the atrioventricular node to any atrial stimulus with a given recovery time during periodic pacing of the atrium is independent of the atrial rate, a simple equation (“map”) can be derived, using the recovery curve. The rhythm of atrioventricular conduction expected at any atrial rate is then obtained by numerically iterating this map on a digital computer. As the atrial rate is increased, rhythms resembling normal sinus rhythm, first-degree atrioventricular block, millisecond Wenckebach, Wenckebach periodicity, reverse Wenckebach periodicity, alternating Wenckebach periodicity, and higher grades of block are successively encountered. A mathematical theorem about the map is invoked to show that these are the only rhythms of conduction permitted. In addition, the order in which the various rhythms will appear as the atrial rate is increased as well as the ordering of blocked atrial beats within a given rhythm of block are also derived. Iteration using recovery curves other than the standard one leads to rhythms in which there is atypical Wenckebach, alternation of the conduction time, or coexistence of two different conduction times. Since this work puts into a common framework many different rhythms of atrioventricular conduction, it forms the beginnings of a “unified theory” of atrioventricular block.

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Authors and Affiliations

  1. Department of Physiology, McGill University, Montréal, Québec, H3G 1Y6, Canada

    Michael R. Guevara

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  1. Michael R. Guevara
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Editors and Affiliations

  1. Department of Physiology, McGill University, Montreal, Quebec, H3G 1Y6, Canada

    Leon Glass

  2. Department of Engineering Science, University of Auckland, Auckland, New Zealand

    Peter Hunter

  3. Department of Applied Mechanics and Engineering Science—Bioengineering, University of California, San Diego, La Jolla, CA, 92093, USA

    Andrew McCulloch

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Guevara, M.R. (1991). Iteration of the Human Atrioventricular (AV) Nodal Recovery Curve Predicts Many Rhythms of AV Block. In: Glass, L., Hunter, P., McCulloch, A. (eds) Theory of Heart. Institute for Nonlinear Science. Springer, New York, NY. https://doi.org/10.1007/978-1-4612-3118-9_13

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  • DOI: https://doi.org/10.1007/978-1-4612-3118-9_13

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